By Madison Avenue TMS & Psychiatry - Published on August 12, 2025

Last updated on August 12, 2025

If you’ve been living with treatment-resistant depression, you know the struggle. Medications don’t work. Talk therapy doesn’t work. It can feel like nothing will ever work. 

At Madison Avenue TMS & Psychiatry, we help patients find relief from depression. One treatment option we consistently see provide life-changing results is TMS (transcranial magnetic stimulation). And through personalized treatment plans, we offer the most advanced TMS protocols available. 

Read on to learn more about TMS and which protocol might be right for you. 

What Is TMS?

“TMS therapy is an FDA-approved, non-invasive form of brain stimulation that uses painless magnetic pulses to stimulate specific areas of the brain,” says Dr. David Woo, head clinical psychiatrist and founder of Madison Avenue TMS & Psychiatry. “As a treatment for depression, it has proven its effectiveness through numerous clinical trials. Treatment usually involves daily 20-minute sessions over several weeks.” 

TMS has also shown promise in treating conditions like anxiety, bipolar disorder, postpartum depression and epilepsy. Unlike electroconvulsive therapy (ECT), TMS doesn’t require anesthesia or cause memory loss. You stay fully awake during each outpatient TMS session. 

How TMS Works

Depression can silence parts of the brain, especially the left dorsolateral prefrontal cortex (DLPFC), the area responsible for joy, energy, focus, and motivation. Low activity in this region often leads to depressive symptoms like fatigue, hopelessness, and emotional numbness.

TMS uses a specialized TMS coil to deliver a magnetic field that reactivates underperforming neurons in specific areas of the brain. Over time, repeated TMS sessions (rTMS) can rebuild healthier brain connections and improve mood and overall outlook.

Targeting Specific Brain Regions with Custom TMS Coils

“Research has shown that certain mental health conditions are particularly responsive when treatment targets specific brain regions. And we target these brain regions by using different TMS coils housed in the TMS helmet,” says Dr. Woo. 

“These coils differ in width, depth, and magnetic frequencies to correspond to the unique makeup of specific brain regions. For example, for Obsessive-Compulsive Disorder (OCD), we use Brainsway’s H7 coil, which targets deeper areas of the brain’s right hemisphere. For depression, we use the H1 coil to target the brain’s left hemisphere.”

Types of TMS Protocols 

A TMS protocol is the combination of frequency levels (pulses per second) and how often they are administered. At Madison Avenue TMS & Psychiatry, we tailor your TMS treatment plan to include specific protocols to match your needs, symptoms, and goals. After a thorough evaluation, your care team will determine which TMS protocol is right for you to ensure your treatment is as effective and personalized as possible. 

High-Frequency TMS

Our most widely used protocol, high-frequency TMS, delivers 18Hz stimulation (18 magnetic pulses per second) to the left cortex. “This approach is ideal for individuals with major depressive disorder who haven’t found relief through antidepressant medications,” says Dr. Woo. “It helps jumpstart brain activity and restore healthy connectivity across your emotional processing centers.”

Bilateral TMS

If you’re one of the many people who live with both depression and anxiety, this protocol may be for you. Bilateral TMS applies high-frequency pulses to the left cortex and low-frequency stimulation to the right cortex to rebalance overactive and underactive areas. It addresses the imbalance of brain activity that can make emotional symptoms feel overwhelming.

Theta Burst TMS (iTBS)

One of the major breakthroughs with TMS has been the discovery of Intermittent Theta Burst Stimulation (iTBS). “When pulses are delivered with multiple specific high frequencies, they can trigger certain brain waves, called theta waves, which are associated with learning,” says Dr. Woo. “By matching up theta waves with high frequencies (5 Hz and 50 Hz), we have a powerful way of producing change in brain regions.”

iTBS is FDA-approved and clinically proven to produce high remission rates with minimal side effects. “We see these results and prescribe iTBS regularly in our clinic, both on its own and as part of our accelerated TMS options,” says Dr. Woo.

Accelerated TMS

Accelerated TMS is an intense, fast-tracked form of TMS treatment not yet covered by insurance. However, first introduced through the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT protocol) study, it serves as an example of how accelerated and innovative treatment protocols can dramatically reduce depressive symptoms. For example, 90% of the study’s participants with treatment-resistant depression achieved remission within just five days.

The SAINT protocol involves 5-10 daily sessions, spaced roughly 50 minutes apart, over five consecutive days. It also uses advanced imaging (fMRI) to identify the precise brain region to target with intermittent theta-burst stimulation (iTBS). 

“Though insurance doesn’t yet cover the SAINT protocol, our practice offers an accessible alternative by combining standard TMS with theta burst sessions,” says Dr. Woo. 

Why Choose TMS 

If you’ve tried antidepressant medication and talk therapy with little success, TMS may be the solution you’ve been searching for.

With TMS, patients have:

• No serious side effects
• No memory loss
• No downtime or hospital stays

TMS is FDA-approved for All Age Groups

Brainsway TMS technology has FDA clearance to treat depression in young, middle-aged and older adults (ages 68–86). Some major healthcare providers even cover TMS treatment for adolescents in specific cases.

We offer thorough evaluations to determine your eligibility and ensure your care is safe, appropriate, and effective at any age.

Take the FIrst Step to Starting Your TMS Treatment 

If you’ve been feeling hopeless or stuck, we want you to know there are options. Our team is here to guide you step by step through your TMS journey, from the first consultation to insurance coordination, to every follow-up.

Contact us to schedule an appointment or to learn more about TMS therapy in New York City. 

Madison Avenue TMS & Psychiatry